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OG35.18 | IUD Procedural Skill — SDL Guide (Part 3)
Self-Assessment
Use the questions and procedural checklist below to evaluate your readiness for IUCD insertion and removal in a supervised clinical setting. Self-assessment at this stage of procedural training serves two interdependent purposes: it identifies specific knowledge or technique gaps before you encounter them in a clinical encounter where the cost of error is borne by a patient, and it develops the metacognitive habit of honest self-evaluation that characterises safe and self-improving clinical practice. The areas you mark as uncertain should be revisited in simulation, not deferred to your first patient contact. Competency in IUCD insertion has two components — technical (correct withdrawal technique, fundal placement) and clinical (correct patient selection, counselling, and complication recognition) — and both must be assessed before supervised practice.
Knowledge check:
1. Name four absolute contraindications (WHO MEC Category 4) to IUCD insertion.
2. Why must the insertion rod remain stationary while the outer tube is withdrawn during CuT 380A deployment?
3. What is the first investigation for missing IUCD threads at 6-week follow-up?
4. A woman with a copper IUCD has a positive pregnancy test and left-sided pain. What is the immediate clinical concern?
5. What is the maximum timeframe for emergency contraceptive copper IUCD insertion?
Procedural self-check (after simulation):
- [ ] I can perform bimanual examination and assess uterine position correctly
- [ ] I can sound the uterus and set the depth indicator accurately
- [ ] I can deploy the CuT 380A using the withdrawal technique (tube back, rod stationary)
- [ ] I can trim threads to 2-3 cm from external os
- [ ] I can perform routine IUCD removal using thread traction
- [ ] I can counsel a patient on WHO MEC Category 4 contraindications and expected side effects
SELF-CHECK
A 32-year-old woman has a copper IUCD inserted. She returns 3 weeks later with lower abdominal pain and purulent vaginal discharge. On examination she has cervical motion tenderness. What is the most appropriate management?
A. Remove the IUCD immediately before starting antibiotics — the device is the source of infection
B. Start antibiotic treatment for PID while leaving the device in place, as unnecessary removal worsens outcomes
C. Admit for IV antibiotics and remove the IUCD after 48 hours regardless of response
D. Reassure and observe — PID in the first 20 days after insertion always resolves without treatment
Reveal Answer
Answer: B. Start antibiotic treatment for PID while leaving the device in place, as unnecessary removal worsens outcomes
WHO and RCOG guidelines both state that in mild-to-moderate IUCD-associated PID, the device should be left in place while the patient is treated with appropriate broad-spectrum antibiotics. Studies show that unnecessary IUCD removal worsens short-term outcomes — it is associated with higher PID severity scores and greater risk of tubal damage compared with treatment with device retention. Remove the device only if the patient fails to improve within 72 hours of adequate antibiotics, if the PID is severe, or if the patient requests removal after informed counselling. Immediate removal (option A) is not first-line per guidelines. Untreated PID (option D) risks tubal infertility and pelvic abscess.